Prevalence and association of somatic symptoms in patients with Major Depressive Disorder.

BACKGROUND Painful and non-painful somatic symptoms are often reported in patients with depressive disorder. The proper identification of depression-relevant somatic symptoms is important for the accurate diagnosis of depression, development of treatment strategies and measurement of outcome. The objective of this study was to characterize the relationship between somatic symptoms and depression in patients diagnosed with Major Depressive Disorder (MDD), using data from randomized drug trials carried out by a pharmaceutical company. METHODS Pooled 'blinded' data from 2191 patients enrolled in randomized, multicenter, double-blind placebo-controlled studies for the treatment of MDD were analyzed. Somatic symptoms were assessed using the Somatic Symptoms Inventory (SSI) and the Hamilton Depression Rating Scale (HAMD) was used to assess symptoms of depression. RESULTS The most common somatic symptom reported by patients with MDD was 'feeling fatigued, weak, or tired all over', with 78% of patients reporting 'moderate' levels or above. This was followed by 'feeling that not in as good physical health as most of your friends' (59%), 'not feeling well most of the time in the past few years' (54%), and 'feeling weak in parts of body' (45%). 'Headache' was the most common pain-related symptom with 43% reporting 'moderate' or above. Pearson's product-moment correlations revealed that somatic symptoms generally increased as a function of overall depressive (r=0.43), with 'feeling fatigued, weak, or tired all over' (r=0.50), 'feeling that not in as good physical health as most of your friends' (r=0.42), 'feeling weak in parts of body' (r=0.41), 'heavy feeling in arms and legs' (r=0.34), 'not feeling well most of the time in the past few years' (r=0.32), and 'headache' (r=0.31) showing the strongest correlation with overall HAMD scores. Non-parametric item response analyses showed that many somatic symptoms demonstrate good relationship between item response and the overall severity of depression. In particular, 'feeling fatigued, weak, or tired all over' exhibited good discriminative properties across the full range of severity for depression. LIMITATIONS The analysis utilized data from a 'restricted' patient population in drug trials sponsored by a pharmaceutical company. CONCLUSIONS These results demonstrate a high prevalence and association of somatic symptoms in patients with MDD, including feelings of fatigue, physical malaise and pain-related symptoms, which could be potentially useful in the assessment of depression and in the evaluation of treatment strategies.

[1]  James O. Ramsay,et al.  Progress in the technology of measurement: Applications of item response models. , 1998 .

[2]  D. Santor,et al.  An Item Response analysis of the Hamilton Depression Rating Scale using shared data from two pharmaceutical companies. , 2004, Journal of psychiatric research.

[3]  P. Keck,et al.  Comorbidity of fibromyalgia with medical and psychiatric disorders. , 1992, The American journal of medicine.

[4]  M. Detke,et al.  Effects of duloxetine on painful physical symptoms associated with depression. , 2004, Psychosomatics.

[5]  E. Wouters,et al.  Are patients with COPD psychologically distressed? , 2005, European Respiratory Journal.

[6]  R. Noyes,et al.  Hypochondriacal Concerns in Panic Disorder and Major Depressive Disorder: A Comparison , 2004, International journal of psychiatry in medicine.

[7]  J. Turner,et al.  Principal dimensions of the pain experience and psychological disturbance in chronic low back pain patients , 1981, Pain.

[8]  M. Olfson,et al.  Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. , 2006, The Journal of clinical psychiatry.

[9]  A. Vaccarino,et al.  Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression , 2008, Depression and anxiety.

[10]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[11]  K Kroenke,et al.  Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome. , 1997, Archives of internal medicine.

[12]  A. Tylee,et al.  The importance of somatic symptoms in depression in primary care. , 2005, Primary care companion to the Journal of clinical psychiatry.

[13]  Terry Brugha,et al.  Comorbid painful physical symptoms and depression: prevalence, work loss, and help seeking. , 2006, Journal of affective disorders.

[14]  H. Möller,et al.  Duloxetine: a new selective and dual-acting antidepressant , 2006, Expert opinion on pharmacotherapy.

[15]  S. Currie,et al.  Chronic back pain and major depression in the general Canadian population , 2004, Pain.

[16]  Elizabeth Wager,et al.  Pain symptoms in depression: definition and clinical significance. , 2005, Clinical medicine.

[17]  E. Paykel,et al.  Residual symptoms at remission from depression: impact on long-term outcome. , 2004, Journal of affective disorders.

[18]  G. Simon,et al.  An international study of the relation between somatic symptoms and depression. , 1999, The New England journal of medicine.

[19]  George I Papakostas,et al.  Symptoms of fatigue and sleepiness in major depressive disorder. , 2006, The Journal of clinical psychiatry.

[20]  Brian Doan,et al.  Relationships between depressive symptoms and descriptions of chronic pain , 1989, Pain.

[21]  J. Marshall.  THE SKIN SENSES , 1969 .

[22]  M. Fava,et al.  What Clinical and Symptom Features and Comorbid Disorders Characterize Outpatients with Anxious Major Depressive Disorder: A Replication and Extension , 2006, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[23]  R. Segraves,et al.  ORIGINAL RESEARCH—WOMEN's SEXUAL DYSFUNCTIONSORIGINAL RESEARCH—WOMEN's SEXUAL DYSFUNCTIONS: The Sexual Interest and Desire Inventory—Female (SIDI‐F): Item Response Analyses of Data from Women Diagnosed with Hypoactive Sexual Desire Disorder , 2005 .

[24]  P. Jacobsen,et al.  Distinguishing fatigue and depression in patients with cancer. , 2003, Seminars in clinical neuropsychiatry.

[25]  R. Segraves,et al.  The Sexual Interest and Desire Inventory-Female (SIDI-F): item response analyses of data from women diagnosed with hypoactive sexual desire disorder. , 2005, The journal of sexual medicine.

[26]  C. Soldatos,et al.  The Measurement of Fatigue in Depression , 2007, Psychopathology.

[27]  S. Kennedy,et al.  Improving outcomes in depression: a focus on somatic symptoms. , 2006, Journal of psychosomatic research.

[28]  L. Kirmayer,et al.  Somatization and the recognition of depression and anxiety in primary care. , 1993, The American journal of psychiatry.

[29]  S. Dworkin,et al.  Psychobiological markers in coexisting pain and depression: toward a unified theory. , 1982, The Journal of clinical psychiatry.

[30]  R Ramana,et al.  Residual symptoms after partial remission: an important outcome in depression , 1995, Psychological Medicine.

[31]  Maurice M Ohayon,et al.  Using chronic pain to predict depressive morbidity in the general population. , 2003, Archives of general psychiatry.

[32]  F. Keefe,et al.  Catastrophizing, depression and the sensory, affective and evaluative aspects of chronic pain , 1994, Pain.

[33]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[34]  M. Härter,et al.  Psychosocial Care by General Practitioners—Where are the Problems? Results of a Demonstration Project on Quality Management in Psychosocial Primary Care , 1999, International Journal of Psychiatry in Medicine.

[35]  R. Lipton,et al.  Headache and major depression , 2000, Neurology.

[36]  G. Klerman,et al.  Hypochondriasis. An evaluation of the DSM-III criteria in medical outpatients. , 1986, Archives of general psychiatry.